New York Times

Saturday, February 15, 2003

By SHAILA K. DEWAN

For the parents of some severely mentally ill children, it can come to this: pleading with emergency-room psychiatrists who have no good answers. Listening grimly as caseworkers explain their lack of options. Appearing tearfully before family court judges as they take what they regard as a last desperate step in pursuit of medical care.

What these mothers and fathers are being urged to do is agonizing: give up custody of their children and turn them over to New York State's child welfare agencies so that they can get the mental health care that they otherwise cannot afford or gain access to.

Repeatedly, these parents say, they are told that giving up their children is the only way to help them. Private insurance does not pay for children who may need a year or more of intense treatment, at costs that can exceed $60,000 a year. For the many who cannot afford that, the number of state-financed beds for mental health patients is tiny and the wait long.

But a child placed in foster care can be sent to facilities that, while not designed to deal with mentally ill children, have many more openings and at least some psychiatric services.

"That was the hardest decision I ever had to make," said Donna O'Clair, who with her husband, Tom, allowed Schenectady County to take custody of their suicidal 11-year-old son when he needed more care than their health insurance would cover.

The state's Office of Children and Family Services, which oversees New York's child welfare agencies, does not keep a count of how many children are turned over to it in need of mental health care. And the state says it discourages the practice by offering alternatives.

But judges, lawyers, social workers and parents from Brooklyn to Buffalo say it happens regularly.

In New York City, for example, officials at the Administration for Children's Services say about half their intensive-care beds are filled not by abused or neglected youngsters, but by those placed there directly by their parents or through a court program for troubled youths that parents enter voluntarily.

"There are all sorts of permutations of folks trying to get into the foster care system because they have not been able to get into the mental health system," said Raymond Schimmer, the executive director of the Parsons Child and Family Center in Albany, which runs mental health and foster care facilities. "In extreme cases, you have parents who claim that they've abused or neglected their children."

For parents who resort to giving up a child, eight of whom were interviewed for this article, the experience is fraught with uncertainties. They have the right to ask for their child back, but must win the approval of a judge. They receive legal notices warning that after 15 months in custody, their child could be put up for adoption. They have no control over where their child is sent or, in some cases, what treatments the child receives. Some parents have, for periods, lost track of their children entirely.

"Do you make children with cancer have their parents give up custody so they get the care they need?" asked Tracy Zeltwanger, a county worker in Watertown, N.Y., who was prodded to relinquish her 9-year-old son, Corey, who has early-onset bipolar disorder, doctors say. Ms. Zeltwanger ultimately refused.

New York parents are not alone. At a time when health care costs are soaring and the number of children with complicated disorders is increasing, the quandary of custody versus care is a phenomenon throughout the country. Thirteen states have passed laws to prohibit the practice of exchanging custody for care, according to the Bazelon Center for Mental Health Law in Washington.

Such a law might help in New York if mental health resources were not so scarce, said James Dillon, a family court judge in Erie County. "But there are a limited number of beds," he said.

For children who need extensive care, New York offers two basic options. There is the one that was explicitly intended for such children: the state mental health system, which has about 540 residential treatment beds.

And there is the one that was not intended for them: the foster care system, which has about 4,000 beds but limited ability to handle mentally ill children.